Liver cancer is different from many other cancers as it develops in a liver that is already diseased. The primary causes of liver disease that can lead to liver cancer include alcoholic liver disease, non-alcoholic fatty liver disease, hepatitis B, and hepatitis C. Prolonged liver damage from these conditions can lead to cirrhosis, a condition where scar tissue replaces a large part of the liver. If left untreated in the early stages, these conditions can result in liver cancer and liver failure.
What are some symptoms of liver cancer?
Dr. Arvinder Singh Soin, Chairman, Institute of Liver Transplantation and Regenerative Medicine, Medanta, Gurugram explains the main symptoms of liver cancer:
- Tiredness, fatigue
- Feeling generally ill or experiencing flu-like symptoms
- Pale skin and eyes, jaundice (yellow and itchy skin, dark urine and pale stools, loss of appetite, or weight loss
How is liver cancer diagnosed?
The diagnosis of liver cancer begins with the identification of liver conditions that may increase the risk of developing cancer. For such patients, screening is first recommended to diagnose the liver condition. “The screening involves a test called an AFP (alpha-fetoprotein) blood test. The elevated AFP test along with ultrasound helps in identifying the lumps in the liver that are suspected to be cancer in patients who are at risk or have one or more symptoms. Another blood test called PIVKA-II is also done, followed by a contrast CT scan of the abdomen and the liver to finally confirm the cancer. A dynamic MRI scan of the liver and abdomen can also diagnose liver cancer,” adds Dr Soin. Once liver cancer has been diagnosed, a liver specialist determines the extent of its spread.
How does liver cancer spread?
- It can spread within the liver in the form of lumps that could be of different sizes, and each of them can enlarge.
- The spread can be in the main blood vessels of the liver, the portal veins, or the hepatic veins.
- In its advanced stage, liver cancer can spread to the lungs, lymph glands, bones, and even the brain.
How do you manage a patient with liver cancer?
Dr Soin explains that the first is the diagnosis, then a full body scan is done (PET scan) to determine the extent of the spread of the cancer. The treatment protocol is decided based on the stage and spread of the cancer.
If the cancer is stage 1 I.e., single, small, less than 2 cm in size, it can be treated without surgery.
Stage 2 is big or multiple cancer lumps that are only confined to the liver. This stage is best cured with a liver transplant.
When there is a single lump less than 3-4 cm in size and in one location, it may be possible to remove that portion of the liver with a liver resection. However, liver transplant is still a better option even for such cancers since the chances of the cancer recurrence are the least with a transplant.
Stage 3 cancer denotes a single cancer over 8 cm or more than 3 cancers. In this case, a transplant is necessary as long as there is no spread outside of the liver.
Stage 4 cancer if the tumor in the portal vein, or spread outside of the liver to another area.
What are some advanced innovations and treatment options now available to treat liver cancer?
Liver resection and transplant with advanced Robotic Surgery techniques are successful. “We have also innovated a new cure for stage 4 cancer invading the portal vein (as long as it has not spread outside the liver) by special low toxicity radiotherapy techniques (TARE, SBRT) to the portal vein tumor followed by a liver transplant,” opines Dr Soin.
Once the cancer has spread outside the liver, then palliative treatment is possible with immunotherapy or targeted therapy medicines.
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Liver cancer prevention and early detection
Liver cancer can be prevented by preventing the diseases that cause it. Alcoholic liver disease can be prevented by avoiding excessive consumption of alcohol.
Non-alcoholic fatty liver disease can be prevented by controlling diabetes well, by maintaining ideal body weight or reducing weight in case one is overweight, controlling elevated lipids and cholesterol, and maintaining a healthy diet and exercise routine.
Hepatitis B can be prevented by universal vaccination. Hepatitis C can be prevented by use of disposable needles, syringes and dialysis machines in hospitals, as well as a screening of the Hepatitis C infection during blood donation, and by avoiding direct sexual contact with infected patients.
Early detection of liver cancer in the above susceptible groups can be done by 6 monthly testing of blood for the cancer market, AFP, and ultrasound of the liver. This aids in the effective treatment of cancer, and approximately 80% of liver cancers are curable in stages 1, 2, and 3.
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